Clinical Features of Combined Central Retinal Artery and Vein Occlusion

Purpose To describe the clinical features of combined central retinal artery and vein occlusion (CCRAVO). Methods This retrospective study included 33 admitted patients (33 eyes) who had CCRAVO. Clinical data, such as age, gender, best-corrected visual acuity (BCVA), intraocular pressure (IOP), findings on fundus color photography and fundus fluorescein angiography (FFA), and information about follow-up, were collected and analyzed. Results The age of the patients with CCRAVO ranged from 22 to 78 years, with a mean of 48.8 ± 14.1 years. At presentation, BCVA of the involved eyes ranged from no light perception (NLP) to 20/20. In addition, 45.5% (15/33) of the eyes had BCVA of finger counting (FC) or below, whereas 12.1% (4/33) had BCVA of 20/60 or above. The IOP was lower in the involved eyes than in the fellow eyes (15.0 ± 3.0 mmHg vs. 16.4 ± 2.3 mmHg, p=0.03). Ophthalmoscopic examination showed changes in both central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO), including retinal hemorrhage, retinal ischemic whitening, optic disc hyperemia and/or edema, venous dilation and tortuosity, cotton wool spot (CWS), and Roth's spot. FFA showed prolonged arm-to-retina time (ART) and retinal arteriovenous passage time (RAP) (17.1 ± 4.9 s and 12.1 ± 8.8 s, respectively). Capillary nonperfusion (CNP) was seen in 21 eyes (63.6%), and in 14 (42.2%) of these, CNP was larger than 10 disc areas. At 2 to 3 weeks after presentation, BCVA improved in 23 eyes (71.9%) and further deteriorated in 5 eyes (15.6%). Retinal ischemic whitening improved in more than half of the eyes, whereas retinal hemorrhage increased in nearly half of the eyes. Follow-up ranged from 6 to 56 months. Seven patients were lost to follow-up. At final follow-up, six eyes had a visual acuity of 20/60 or greater, but 6 eyes had FC or worse. Four eyes developed neovascularization on follow-up. Conclusion CCRAVO is a sight-threatening entity. Manifestations of CRAO and CRVO can be seen simultaneously in the early stage of disease, and CRVO may play a more important role in the development of CCRAVO.

[1]  M. Pourazizi,et al.  Acute vision loss in systemic lupus erythematosus: bilateral combined retinal artery and vein occlusion as a catastrophic form of clinical flare , 2018, Lupus.

[2]  D. Misra,et al.  Combined central retinal artery and vein occlusion in lupus , 2017, BMJ Case Reports.

[3]  Prabu Baskaran,et al.  Retinal Vascular Occlusion Secondary to Retrobulbar Injection: Case Report and Literature Review , 2017, Middle East African journal of ophthalmology.

[4]  S. Parchand.  Combined central retinal vein and branch retinal artery occlusion in hyperhomocysteinaemia , 2016, BMJ Case Reports.

[5]  Seong Joon Ahn,et al.  Incidence and Clinical Features of Neovascularization of the Iris following Acute Central Retinal Artery Occlusion , 2016, Korean journal of ophthalmology : KJO.

[6]  Imen Khairallah Ksiaa,et al.  Occlusion combinée de l’artère centrale de la rétine et de la veine centrale de la rétine révélant une maladie de Behçet , 2016 .

[7]  L. el Matri,et al.  Combined central retinal arterial and venous occlusion after ocular contusion. , 2016, Journal francais d'ophtalmologie.

[8]  R. Kahloun,et al.  [Combined central retinal artery occlusion and central retinal vein occlusion secondary to Behçet's disease]. , 2016, Journal francais d'ophtalmologie.

[9]  J. Sowka,et al.  Atypical Retinal Vaso-Occlusion with Structural and Functional Resolution , 2015, Optometry and vision science : official publication of the American Academy of Optometry.

[10]  R. Méndez,et al.  Edema de papila y obstrucción de arteria y vena central de la retina como manifestación inicial de una recaída leucémica , 2014 .

[11]  M. Fonollá Gil,et al.  Unilateral optic disk edema with central retinal artery and vein occlusions as the presenting signs of relapse in acute lymphoblastic leukemia. , 2014, Archivos de la Sociedad Espanola de Oftalmologia.

[12]  D. Schmidt.  Comorbidities in combined retinal artery and vein occlusions , 2013, European Journal of Medical Research.

[13]  H. Terasaki,et al.  Bilateral central retinal artery occlusion and vein occlusion complicated by severe choroidopathy in systemic lupus erythematosus , 2013, Lupus.

[14]  H. Hwang,et al.  Combined central retinal vein and artery occlusion in systemic lupus erythematosus patient. , 2012, Retinal cases & brief reports.

[15]  S. Hayreh,et al.  Natural history of visual outcome in central retinal vein occlusion. , 2011, Ophthalmology.

[16]  W. Chen,et al.  Combined central retinal artery and vein occlusion in a patient with systemic lupus erythematosus and anti-phospholipid syndrome , 2010, Lupus.

[17]  L. Yannuzzi,et al.  Intravitreal triamcinolone and bevacizumab therapy for combined papillophlebitis and central retinal artery occlusion. , 2010, Retinal cases & brief reports.

[18]  S. Hayreh,et al.  Central Retinal Vein Occlusion Associated With Cilioretinal Artery Occlusion , 2008, Retina.

[19]  S. Hayreh,et al.  Central retinal artery occlusion: visual outcome. , 2005, American journal of ophthalmology.

[20]  E. Cunningham,et al.  Posterior scleritis causing combined central retinal artery and vein occlusion. , 2004, Retina.

[21]  Á. Panizo-Santos,et al.  Central retinal vascular occlusion by orbital pseudotumor. , 2004, Retina.

[22]  Gary C. Brown,et al.  Combined central retinal artery-central vein obstruction , 1993, International Ophthalmology.

[23]  S. Hayreh,et al.  Intraocular pressure abnormalities associated with central and hemicentral retinal vein occlusion. , 2004, Ophthalmology.

[24]  P. Adeleine,et al.  Combined central retinal arterial and venous obstruction: emergency ophthalmic arterial fibrinolysis. , 2002, Radiology.

[25]  J. Duker,et al.  Iris neovascularization associated with obstruction of the central retinal artery. , 1988, Ophthalmology.

[26]  W. A. J. Heuven,et al.  Experimental retinal vascular occlusion. I. Pathogenesis of central retinal vein occlusion. , 1978, Archives of ophthalmology.